ABSTRACT: To investigate the clinical value of differential white blood cell counts and neutrophil-to-lymphocyte ratio (NLR), by themselves or as adjunct to CA-125, in the diagnosis of endometriosis.
University Medical Center.
Two hundred thirty-one patients with endometriosis, 145 patients with benign ovarian tumors, and 384 healthy controls participated in this study.
Sensitivities and specificities of differential white blood cell (WBC) counts, NLR, serum CA-125, and the combined marker (NLR and serum CA-125) were evaluated by receiver-operating characteristic (ROC) analysis.
The mean NLR and the combined marker in patients with endometriosis were significantly higher than those in patients without endometriosis. The NLR was able to discriminate patients with endometriosis from those with benign ovarian tumors and from healthy controls, and 25 of the 38 endometriosis patients (65.8%) with minimal-to-mild disease exceeded the cutoff value. The combined marker had a sensitivity of 69.3% and specificity of 83.9% with a cutoff value of 55.7, showing 13.5% increase in sensitivity but 8.9% decrease in specificity when compared with serum CA-125 at a cutoff level of 35 IU/mL. The elevated combined marker detected 16 patients with endometriosis (42.1%) with minimal-to-mild disease, whereas only 10 patients (26.3%) had their serum CA-125 levels at more than 35 IU/mL.
Measurement of NLR and the combined marker may be used as simple and easily obtained diagnostic markers for endometriosis.
Fertility and sterility 07/2008; 90(6):2073-9. · 3.97 Impact Factor
ABSTRACT: The aim of this study was to evaluate the long-term clinical effects of a levonorgestrel-releasing intrauterine device (LNG-IUD) on adenomyosis.
A LNG-IUD was inserted into 47 patients who were diagnosed with adenomyosis. Uterine volume, uterine artery blood flow, pictorial blood loss assessment chart (PBAC) scores, and the degree of dysmenorrhea were evaluated before and 36 months after insertion of the LNG-IUD.
Pain scores and PBAC scores dropped dramatically in 6 months and showed significant decrease after 36 months. A significant decrease in mean uterine volume was noted 12 months (156.85 +/- 49.79 mL to 118.64 +/- 41.36 mL; P < .001) and 24 months (128.84 +/- 48.70 mL; P < .001) after LNG-IUD insertion, but no significant differences were noted at 36 months. The mean pulsatility indices of both uterine arteries increased significantly 12 months after insertion (P = .002 for right; P = .011 for left) and decreased after 24 months without significance. Uterine volume and uterine blood flow were negatively correlated (Pearson's correlation, P < .05). Significant increase of uterine volume, pain scores, and PBAC scores were noted at 36 months compared with 12 months after insertion (P = .034, .021, and .001, respectively).
For patients with clinical diagnosis of adenomyosis, the LNG-IUD is effective for the reduction of uterine volume with improvement of vascularity and relief of symptoms. However, the efficacy of LNG-IUD on uterine volume may begin to decrease 2 years after insertion.
American journal of obstetrics and gynecology 04/2008; 198(4):373.e1-7. · 3.28 Impact Factor
ABSTRACT: The aim of this study was to evaluate serum and urinary levels of vascular endothelial growth factors, tumor necrosis factor-alpha (TNF-alpha), and soluble fms-like tyrosine kinase (sFlt-1) in patients with endometriosis.
During surgery for pelvic pain, pelvic mass or infertility, serum and urine were collected. Of 70 patients, 46 had histology-proven endometriosis and 24 patients without endometriosis participated as controls.
Serum TNF-alpha levels and urinary sFlt-1 levels corrected for creatinine excretion were significantly increased in the endometriosis group (P=0.001 and P=0.011 respectively). Serum sFlt-1 levels and urinary sFlt-1 levels corrected for creatinine were significantly higher in patients with minimal-to-mild disease (P=0.014 and P=0.015 respectively), where serum TNF-alpha levels were increased in moderate-to-severe endometriosis (P<0.001).
The pathogenesis of minimal-to-mild endometriosis and moderate-to-severe endometriosis seems to be different. Increased sFlt-1 levels in serum and urine of minimal-to-mild disease indicate that sFlt-1 may have an important role in inhibiting angiogenic process of the disease.
American journal of reproductive immunology (New York, N.Y.: 1989) 12/2007; 58(6):497-504. · 3.05 Impact Factor